Chronic Adherence to a Ketogenic Diet Modifies Iron Metabolism in Elite Athletes
Abstract
Purpose The short-term restriction of carbohydrate (CHO) can potentially influence iron regulation via modification of postexercise interleukin-6 (IL-6) and hepcidin levels. This study examined the effect of a chronic ketogenic low-CHO high-fat (LCHF) diet on iron status and iron-regulatory markers in elite athletes. Methods International-level race walkers (n = 50) were allocated to one of three dietary interventions: (i) a high-CHO diet (n = 16), (ii) a periodized CHO availability (n = 17), or (iii) an LCHF diet (n = 17) while completing a periodized training program for 3 wk. A 19- to 25-km race walking test protocol was completed at baseline and after adaptation, and changes in serum ferritin, IL-6, and hepcidin concentrations were measured. Results from high-CHO and periodized CHO were combined into one group (CHO; n = 33) for analysis. Results The decrease in serum ferritin across the intervention period was substantially greater in the CHO group (37%) compared with the LCHF (23%) group (P = 0.021). After dietary intervention, the postexercise increase in IL-6 was greater in LCHF (13.6-fold increase; 95% confidence interval [CI] = 7.1-21.4) than athletes adhering to a CHO-rich diet (7.6-fold increase; 95% CI = 5.5-10.2; P = 0.033). Although no significant differences occurred between diets, CI values indicate that 3 h postexercise hepcidin concentrations were lower after dietary intervention compared with baseline in CHO (β = -4.3; 95% CI = -6.6 to -2.0), with no differ…
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Carbohydrate-rich diets in international-level racewalkers exhibited more favorable changes to post-exercise IL-6 and hepcidin compared to low carbohydrate, high fat diets, which improved iron availability during a 3-week training program.
“CHO-rich diets in international-level racewalkers (n = 31 males, 6 females) exhibited more favorable changes to post-exercise IL-6 and hepcidin, compared to LCHF, which improved iron availability during a 3-week training program [35].”
From Considerations of Low Carbohydrate Availability (LCA) to Relative Energy Deficiency in Sport (RED-S) in Female Endurance Athletes: A Narrative Review (2023) · cites this paper as [35]
Low carbohydrate availability ranges have not been established based on these criteria for carbohydrate availability, and many studies continue to report carbohydrate intake, using low carbohydrate intake to define intake below current recommendations.
“Nonetheless, LCA ranges have not been established based on these criteria for CHO availability, and many studies continue to report CHO intake, using low CHO intake to define intake below current recommendations [34,35,36,37,38,39,40,41,42,43].”
From Considerations of Low Carbohydrate Availability (LCA) to Relative Energy Deficiency in Sport (RED-S) in Female Endurance Athletes: A Narrative Review (2023) · cites this paper as [35]
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“The role of IL-6 however, extends beyond that of hepatic glucose regulation, also being a key regulator of hepcidin activity (10), particularly during the acute post-exercise recovery period (16).”
BackgroundBurke, L. M., Ross, M. L., Garvican‐Lewis, L. A., Welvaert, M., Heikura, I. A., Forbes, S. G., Mirtschin, J. G., Cato, L. E., Strobel, N., Sharma, A. P., et al. (2017) · The Journal of Physiology · doi:10.1113/jp273230 · Cited by 407 · see citing works
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“A substantial increase in IL-6 occurred across the ~2 h exercise bout during both Baseline and Adapt trials (F(1,150)=343.”
BackgroundResultInfluentialRethinking fat as a fuel for endurance exercise
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Iron considerations for the athlete: a narrative review
Sim, M., Garvican-Lewis, L. A., Cox, G. R., Govus, A., McKay, A. K. A., Stellingwerff, T., & Peeling, P. (2019) · European Journal of Applied Physiology · doi:10.1007/s00421-019-04157-y · Cited by 274 · see citing works
Self-citationA short-term ketogenic diet impairs markers of bone health in response to exercise
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Self-citationIron Metabolism: Interactions with Energy and Carbohydrate Availability
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- Authors
- MCKAY, A. K. A., PEELING, P., PYNE, D. B., WELVAERT, M., TEE, N., LECKEY, J. J., SHARMA, A. P., ROSS, M. L. R., GARVICAN-LEWIS, L. A., SWINKELS, D. W., LAARAKKERS, C. M., & BURKE, L. M.
- Affiliations
- The University of Western Australia (AU)
- University of Canberra (AU)
- Australian Institute of Sport, Bruce, ACT, AUSTRALIA;
- Australian Catholic University (AU)
- Radboud University Medical Center (NL)
- ORCID
- Venue
- Medicine & Science in Sports & Exercise
- Published
- 2019-03
- Volume
- 51
- Issue
- 3
- Pages
- 548-555
- ISSN
- 0195-9131 (ISSN-L)
- 1530-0315
- OpenAlex
- W2898142837
- Cited by
- 53
- References
- 9
- Citations by year
- 2026: 1 · 2025: 9 · 2024: 3 · 2023: 8 · 2022: 7 · 2021: 8 · 2020: 8 · 2019: 8 · 2018: 1
- FWCI
- 4.48
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Medicine & Science in Sports & Exercise (publishedVersion)
- PubMed (publishedVersion)
- UWA Profiles and Research Repository (UWA) (submittedVersion)
- Research Bank (Australian Catholic University) (submittedVersion)
- Radboud Repository (Radboud University) (submittedVersion)
- Griffith Research Online (submittedVersion)
- Topics
- Health Sciences › Medicine › Hematology › Iron Metabolism and Disorders
- Health Sciences › Medicine › Rehabilitation › Exercise and Physiological Responses
- Health Sciences › Medicine › Physiology › Diet and metabolism studies
- Keywords
- ketogenic diet, low-carbohydrate high-fat diet, iron metabolism, serum ferritin, interleukin-6, hepcidin, carbohydrate restriction, elite athletes, race walking
- MeSH terms
- Adult, Dietary Carbohydrates, Female, Ferritins, Humans, Iron, Male, Interleukin-6, Walking, Diet, Ketogenic, Young Adult, Athletes, Hepcidins, Physical Conditioning, Human
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